NSG 3253 Pharm II Final Exam Predictor | Most
Frequently Tested Questions with Detailed
Rationales
Question 1
A patient with heart failure is receiving digoxin. Which laboratory result
would most significantly increase the patient's risk for developing
digoxin toxicity?
• A. Serum potassium level of 3.2 mEq/L
• B. Serum sodium level of 132 mEq/L
• C. Serum calcium level of 9.5 mg/dL
• D. Serum magnesium level of 2.0 mEq/L
Correct Answer: A. Serum potassium level of 3.2 mEq/L
Detailed Rationale: Hypokalemia (low potassium) increases the risk of
digoxin toxicity because potassium and digoxin compete for the same
binding sites on the Na+/K+ ATPase pump. When potassium is low,
more digoxin can bind, leading to toxic effects even if the digoxin level is
within the therapeutic range.
Question 2
A nurse is providing discharge teaching for a patient prescribed warfarin
for atrial fibrillation. Which statement by the patient indicates a need
for further instruction?
• A. "I will use a soft-bristled toothbrush to prevent gum bleeding."
, • B. "I will increase my intake of spinach and kale to stay healthy."
• C. "I will need regular blood tests to check my INR levels."
• D. "I will report any dark, tarry stools to my doctor immediately."
Correct Answer: B. "I will increase my intake of spinach and kale to stay
healthy."
Detailed Rationale: Warfarin works by antagonizing Vitamin K. Leafy
greens like spinach and kale are high in Vitamin K. A sudden increase in
Vitamin K intake can decrease the effectiveness of warfarin, potentially
leading to clot formation. Patients are taught to maintain a consistent
intake rather than increasing it.
Question 3
A patient newly prescribed lisinopril for hypertension reports a
persistent, dry, non-productive cough. What is the most appropriate
nursing action?
• A. Advise the patient to take an over-the-counter cough
suppressant.
• B. Instruct the patient to increase fluid intake to soothe the throat.
• C. Notify the provider as the medication may need to be changed
to an ARB.
• D. Explain that this is a normal side effect that will resolve in 24
hours.
Correct Answer: C. Notify the provider as the medication may need to
be changed to an ARB.
,Detailed Rationale: A dry cough is a common side effect of ACE
inhibitors due to the accumulation of bradykinin in the lungs. It does
not resolve with treatment and is often a reason for non-compliance.
Providers typically switch the patient to an Angiotensin II Receptor
Blocker (ARB) which does not affect bradykinin.
Question 4
The nurse is preparing to administer NPH insulin and Regular insulin to
a patient with Type 1 Diabetes. In which order should the nurse draw
the medications into the syringe?
• A. Draw the NPH (cloudy) insulin first, then the Regular (clear)
insulin.
• B. Draw the Regular (clear) insulin first, then the NPH (cloudy)
insulin.
• C. Draw each insulin in a separate syringe to avoid any
contamination.
• D. The order does not matter as long as the total units are correct.
Correct Answer: B. Draw the Regular (clear) insulin first, then the NPH
(cloudy) insulin.
Detailed Rationale: To prevent contaminating the clear (short-acting)
insulin vial with the cloudy (intermediate-acting) NPH insulin, the nurse
must always draw "clear to cloudy." This ensures the fast-acting insulin
remains pure and effective for mealtime coverage.
Question 5
, A patient taking metformin for Type 2 Diabetes is scheduled for a CT
scan with intravenous contrast dye. Which instruction is most important
for the nurse to provide?
• A. Increase the dose of metformin the morning of the procedure.
• B. Take the metformin with a high-fat meal before the CT scan.
• C. Discontinue metformin 48 hours before and after the
procedure.
• D. Metformin should be taken as usual to maintain glucose
control.
Correct Answer: C. Discontinue metformin 48 hours before and after
the procedure.
Detailed Rationale: Both metformin and IV contrast dye are excreted by
the kidneys. If contrast-induced nephropathy occurs, metformin can
accumulate in the body, significantly increasing the risk of life-
threatening lactic acidosis. It is standard practice to hold it for 48 hours
following the use of contrast.
Question 6
Which teaching point is most critical for a patient starting levothyroxine
for hypothyroidism?
• A. Take the medication with a full meal to prevent gastric upset.
• B. The medication should be taken at bedtime with a glass of milk.
• C. Take the medication on an empty stomach 30-60 minutes
before breakfast.
• D. Stop the medication immediately if you feel your heart racing.
Frequently Tested Questions with Detailed
Rationales
Question 1
A patient with heart failure is receiving digoxin. Which laboratory result
would most significantly increase the patient's risk for developing
digoxin toxicity?
• A. Serum potassium level of 3.2 mEq/L
• B. Serum sodium level of 132 mEq/L
• C. Serum calcium level of 9.5 mg/dL
• D. Serum magnesium level of 2.0 mEq/L
Correct Answer: A. Serum potassium level of 3.2 mEq/L
Detailed Rationale: Hypokalemia (low potassium) increases the risk of
digoxin toxicity because potassium and digoxin compete for the same
binding sites on the Na+/K+ ATPase pump. When potassium is low,
more digoxin can bind, leading to toxic effects even if the digoxin level is
within the therapeutic range.
Question 2
A nurse is providing discharge teaching for a patient prescribed warfarin
for atrial fibrillation. Which statement by the patient indicates a need
for further instruction?
• A. "I will use a soft-bristled toothbrush to prevent gum bleeding."
, • B. "I will increase my intake of spinach and kale to stay healthy."
• C. "I will need regular blood tests to check my INR levels."
• D. "I will report any dark, tarry stools to my doctor immediately."
Correct Answer: B. "I will increase my intake of spinach and kale to stay
healthy."
Detailed Rationale: Warfarin works by antagonizing Vitamin K. Leafy
greens like spinach and kale are high in Vitamin K. A sudden increase in
Vitamin K intake can decrease the effectiveness of warfarin, potentially
leading to clot formation. Patients are taught to maintain a consistent
intake rather than increasing it.
Question 3
A patient newly prescribed lisinopril for hypertension reports a
persistent, dry, non-productive cough. What is the most appropriate
nursing action?
• A. Advise the patient to take an over-the-counter cough
suppressant.
• B. Instruct the patient to increase fluid intake to soothe the throat.
• C. Notify the provider as the medication may need to be changed
to an ARB.
• D. Explain that this is a normal side effect that will resolve in 24
hours.
Correct Answer: C. Notify the provider as the medication may need to
be changed to an ARB.
,Detailed Rationale: A dry cough is a common side effect of ACE
inhibitors due to the accumulation of bradykinin in the lungs. It does
not resolve with treatment and is often a reason for non-compliance.
Providers typically switch the patient to an Angiotensin II Receptor
Blocker (ARB) which does not affect bradykinin.
Question 4
The nurse is preparing to administer NPH insulin and Regular insulin to
a patient with Type 1 Diabetes. In which order should the nurse draw
the medications into the syringe?
• A. Draw the NPH (cloudy) insulin first, then the Regular (clear)
insulin.
• B. Draw the Regular (clear) insulin first, then the NPH (cloudy)
insulin.
• C. Draw each insulin in a separate syringe to avoid any
contamination.
• D. The order does not matter as long as the total units are correct.
Correct Answer: B. Draw the Regular (clear) insulin first, then the NPH
(cloudy) insulin.
Detailed Rationale: To prevent contaminating the clear (short-acting)
insulin vial with the cloudy (intermediate-acting) NPH insulin, the nurse
must always draw "clear to cloudy." This ensures the fast-acting insulin
remains pure and effective for mealtime coverage.
Question 5
, A patient taking metformin for Type 2 Diabetes is scheduled for a CT
scan with intravenous contrast dye. Which instruction is most important
for the nurse to provide?
• A. Increase the dose of metformin the morning of the procedure.
• B. Take the metformin with a high-fat meal before the CT scan.
• C. Discontinue metformin 48 hours before and after the
procedure.
• D. Metformin should be taken as usual to maintain glucose
control.
Correct Answer: C. Discontinue metformin 48 hours before and after
the procedure.
Detailed Rationale: Both metformin and IV contrast dye are excreted by
the kidneys. If contrast-induced nephropathy occurs, metformin can
accumulate in the body, significantly increasing the risk of life-
threatening lactic acidosis. It is standard practice to hold it for 48 hours
following the use of contrast.
Question 6
Which teaching point is most critical for a patient starting levothyroxine
for hypothyroidism?
• A. Take the medication with a full meal to prevent gastric upset.
• B. The medication should be taken at bedtime with a glass of milk.
• C. Take the medication on an empty stomach 30-60 minutes
before breakfast.
• D. Stop the medication immediately if you feel your heart racing.
